13th February 2025

A 50-year-old lady presents with bilateral, gradual-onset ptosis and diplopia.

A 50-year-old lady presents with bilateral, gradual-onset ptosis and diplopia. She has a past medical history of hyperthyroidism, diabetes and rheumatoid arthritis.

She is unable to maintain an upward gaze for more than 10 seconds. She also demonstrates fatigability of the proximal upper limbs. She denies any headaches or neck pain and her FEV1 is within normal range.

Which of the following signs would be in keeping with the diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.